First-line antihypertensive treatment in patients with pre-diabetes: Rationale, design and baseline results of the ADaPT investigation

<p>Abstract</p> <p>Background</p> <p>Recent clinical trials reported conflicting results on the reduction of new-onset diabetes using RAS blocking agents. Therefore the role of these agents in preventing diabetes is still not well defined. Ramipril is an ACE inhibitor (ACEi), that has been shown to reduce cardiovascular events in high risk patients and post-hoc analyses of the HOPE trial have provided evidence for its beneficial action in the prevention of diabetes.</p> <p>Methods</p> <p>The ADaPT investigation ("ACE inhibitor-based versus diuretic-based antihypertensive primary treatment in patients with pre-diabetes") is a 4-year open, prospective, parallel group phase IV study. It compares an antihypertensive treatment regimen based on ramipril versus a treatment based on diuretics or betablockers. The primary evaluation criterion is the first manifestation of type 2 diabetes. The study is conducted in primary care to allow the broadest possible application of its results. The present article provides an outline of the rationale, the design and baseline characteristics of AdaPT and compares these to previous studies including ASCOT-BLPA, VALUE and DREAM.</p> <p>Results</p> <p>Until March 2006 a total of 2,015 patients in 150 general practices (general physicians and internists) throughout Germany were enrolled. The average age of patients enrolled was 67.1 ± 10.3 years, with 47% being male and a BMI of 29.9 ± 5.0 kg/m². Dyslipidemia was present in 56.5%. 37.8% reported a family history of diabetes, 57.8% were previously diagnosed with hypertension (usually long standing). The HbA1c value at baseline was 5.6 %. Compared to the DREAM study patients were older, had more frequently hypertension and patients with cardiovascular disease were not excluded.</p> <p>Conclusion</p> <p>Comparing the ADaPT design and baseline data to previous randomized controlled trial it can be acknowledged that AdaPT included patients with a high risk for diabetes development. Results are expected to be available in 2010. Data will be highly valuable for clinical practice due to the observational study design.</p

Ramipril-based versus diuretic-based antihypertensive primary treatment in patients with pre-diabetes (ADaPT) study

<p>Abstract</p> <p>Background</p> <p>Previous randomized controlled trials demonstrated a protective effect of renin angiotensin system blocking agents for the development of type-2 diabetes in patients with pre-diabetes. However, there are no real-world data available to illustrate the relevance for clinical practice.</p> <p>Methods</p> <p>Open, prospective, parallel group study comparing patients with an ACE inhibitor versus a diuretic based treatment. The principal aim was to document the first manifestation of type-2 diabetes in either group.</p> <p>Results</p> <p>A total of 2,011 patients were enrolled (mean age 69.1 ± 10.3 years; 51.6% female). 1,507 patients were available for the per-protocol analysis (1,029 ramipril, 478 diuretic group). New-onset diabetes was less frequent in the ramipril than in the diuretic group over 4 years. Differences were statistically different at a median duration of 3 years (24.4% vs 29.5%; p < 0.05). Both treatments were equally effective in reducing BP (14.7 ± 18.0/8.5 ± 8.2 mmHg and 12.7 ± 18.1/7.0 ± 8.3 mmHg) at the 4 year follow-up (p < 0.001 vs. baseline; p = n.s. between groups). In 38.6% and 39.7% of patients BP was below 130/80 mmHg (median time-to-target 3 months). There was a significant reduction of cardiovascular morbidity and mortality in favour of ramipril (p = 0.033). No significant differences were found for a change in HbA1c as well as for fasting blood glucose levels during follow-up. The rate of adverse events was higher in diuretic treated patients (SAE 15.4 vs. 12.4%; p < 0.05; AE 26.6 vs. 25.6%; p = n.s).</p> <p>Conclusions</p> <p>Ramipril treatment is preferable over diuretic based treatment regimens for the treatment of hypertension in pre-diabetic patients, because new-onset diabetes is delayed.</p

Consensus recommendations for the use of Ambulatory Glucose Profile in clinical practice

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Gaps and barriers in the control of blood glucose in people with type 2 diabetes

Background: Glycaemic control is suboptimal in a large proportion of people with type 2 diabetes who are consequently at an increased and avoidable risk of potentially severe complications. We sought to explore attitudes and practices among healthcare professionals that may contribute to suboptimal glycaemic control through a review of recent relevant publications in the scientific literature. Methods: An electronic search of the PubMed database was performed to identify relevant publications from January 2011 to July 2015. The electronic search was complemented by a manual search of abstracts from key diabetes conferences in 2014/2015 available online. Results: Recently published data indicate that glycaemic control is suboptimal in a substantial proportion (typically 40%-60%) of people with diabetes. This is the case across geographic regions and in both low- and higher-income countries. Therapeutic inertia appears to be an important contributor to poor glycaemic control in up to half of people with type 2 diabetes. In particular, prescribers are often willing to tolerate extended periods of 'mild' hyperglycaemia as well as having low expectations for their patients. There are often delays of 3 years or longer in initiating or intensifying glucose-lowering therapy when needed. Conclusion: Many people with type 2 diabetes are failed by current management, with approximately half not achieving or maintaining appropriate target blood glucose levels, leaving these patients at increased and avoidable risk of serious complications. Review criteria: The methodology of this review article is detailed in the 'Methods' section

Proceedings of PVP2005 2005 ASME Pressure Vessels and Piping Division Conference PVP2005-71557 FLUID MODELS IN LS-DYNA AND THEIR INTERACTION WITH A STRUCTURE IN DYNAMIC SIMULATIONS

ABSTRACT The paper outlines different approaches to fluid-structure interaction modelling in LS-DYNA. Different formulations (Lagrange, Euler, ALE and SPH) are evaluated and compared with experimental observations of a fluid sloshing problem in a simple container box. Computational simulations have shown that the motion of the fluid can be best described also with the ALE and SPH methods in LS-DYNA. Additionally, such methods are very economical and suitable for analyses of large and more complex models

Computational modelling of fuel motion and its interaction with the reservoir structure

Računalniški modeli vozil za simuliranje trkov vedno natančneje opisujejo obnašanje resničnih vozil. Rezervoar za gorivo je eden izmed elementov vozil, katerega računalniški modeli so bili do sedaj zelo poenostavljeni. Takšni modeli upostevajo le vztrajnost mase goriva, ki je z masnimi točkami pritrjenana steno rezervoarja, vendar pa je vpliv gibanja goriva v rezervoarju popolnoma zanemarjen. Prispevek opisuje nove računalniske modele, s katerimi je mogoče simulirati deformacijo rezervoarja za gorivo ob upoštevanju gibanja goriva pri trku vozila. V ta namen so bile vrednotene štiri metode simuliranje gibanja tekočine (Lagrange, Euler, poljubnostna Lagrange-Eulerjeva metoda - PLE in hidrodinamika zglajenih delcev - HZD) v rezervoarju preproste oblike, analizirane z eksplicitnim programom LS-DYNA. Računalniski rezultati so bili primerjani s poprej objavljenimi preizkusnimi opazovanji, pri čemer je bila ugotovljena zelo dobra primerljivost med rezultati. Najprimernejsi metodi (HZD in PLE) sta bili kasneje uporabljeni v dinamičnih simulacijah dejanskega rezervoarja za gorivo. Simulacije so pokazale, da predstavljeni modeli rezervoarja ob upostevanju gibanja goriva zagotavljajo mnogo natančnejše rezultate v primerjavi z znanimi poenostavljenimi modeli.Computational models of vehicles for crash simulations are ever more precisely describing the behaviour of real vehicles. A fuel-tank is a typical vehicle element that has been very simplified in the computational models used so far. Such models have considered only the influence of the fuel mass inertia, which was point-wise connected to the tank walls, with total neglect of the fuel motion in the tank. This paper describes new computational models that allow for a simulation of the fuel-tank deformation considering the fuel motion during a vehicle crash. For this purpose four different methods for describing fluid motion (Lagrangian, Eulerian, Arbitrary Lagrange-Eulerian description - ALE, SPH) were evaluated on a simple reservoir problem, analysed with the explicit dynamic code LS-DYNA. The computational results were compared with previously published experimental observations and a good correlation of the results was observed. The most appropriate methods, SPH and ALE, were afterwards used in dynamic simulations of a real fuel-tank. The simulations showed that by also taking into consideration the fuel motion, the proposed computational models provide more accurate results in comparison with the previously used, simplified models